Treatment for Sore Throat and Running Nose (Viral Upper Respiratory Infection)
For a sore throat and running nose caused by a viral upper respiratory infection, treat symptomatically with analgesics (acetaminophen or ibuprofen), nasal saline irrigation, and optionally topical intranasal corticosteroids—antibiotics should NOT be prescribed as they are ineffective for viral illness and contribute to antimicrobial resistance. 1, 2
First-Line Symptomatic Treatment
The American Academy of Otolaryngology-Head and Neck Surgery provides clear guidance that viral rhinosinusitis (the common cold) should be managed with symptomatic relief only 1:
- Analgesics/antipyretics (acetaminophen or ibuprofen) for pain relief and fever control 1, 2
- Nasal saline irrigation to relieve nasal congestion and facilitate clearance of secretions 1, 2
- Topical intranasal corticosteroids may provide modest symptom relief, though evidence is limited 1, 2
These symptoms typically peak within 3 days and resolve within 10-14 days without specific treatment 2.
Additional Symptomatic Options
If first-line measures are insufficient, consider:
- Oral decongestants (such as pseudoephedrine) can provide symptomatic relief, but use with caution in patients with hypertension, anxiety, or cardiac conditions 1, 2
- Topical nasal decongestants should be limited to 3-5 days maximum to avoid rebound congestion (rhinitis medicamentosa) 2
- First-generation antihistamine/decongestant combinations may reduce symptoms, though newer non-sedating antihistamines are relatively ineffective for viral upper respiratory infections 2, 3
What NOT to Do
Antibiotics are contraindicated for viral upper respiratory infections 1, 2:
- Antibiotics are ineffective for viral illness and do not relieve symptoms directly 1, 2
- They add unnecessary costs, risk adverse effects, and contribute to antimicrobial resistance 3, 4
- Multiple high-quality studies confirm no benefit from antibiotics for the common cold 4
- Sputum color (clear, cloudy, or colored) should NOT be used to justify antibiotic therapy, as color relates to neutrophils, not bacteria 1
When to Consider Bacterial Infection
Only consider antibiotics if the patient meets criteria for acute bacterial rhinosinusitis 1, 5:
- Symptoms persist ≥10 days without improvement 1, 5
- "Double worsening": symptoms worsen after initial improvement within the first 10 days 1, 5
- Severe symptoms: fever >39°C (102.2°F), purulent nasal discharge, and facial pain for ≥3 consecutive days 5
If bacterial infection is confirmed, amoxicillin with or without clavulanate is first-line therapy for 5-10 days 1.
Common Pitfalls to Avoid
- Do not prescribe antibiotics for symptoms lasting <7-10 days, as this is almost certainly viral 5, 6
- Do not use topical decongestants beyond 3-5 days to prevent rebound congestion 2
- Do not obtain imaging for uncomplicated upper respiratory symptoms, as it has high false-positive rates and does not change management 1, 5
- Do not underutilize simple measures like saline irrigation and adequate hydration, which provide significant relief 2
Patient Education Points
- Inform patients that 40-60% of viral upper respiratory infections resolve spontaneously without treatment 2
- Explain that antibiotics will not shorten the duration or severity of viral symptoms 1, 4
- Advise patients to return if symptoms persist beyond 10 days, worsen after initial improvement, or if high fever develops 1, 5
- Emphasize adequate rest and hydration to support recovery 2, 7